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General NPI Number Information
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NPI Number | 1790797108
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Entity Type | Individual
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Provider Name | JOANNE PECK MD
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 14 DOCTORS CIR SUITE 3
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City | SUPPLY
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State | NC
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Zip | 28462-4097
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Country | US
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Telephone | 910-754-7075
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Fax | 910-754-2158
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Provider Business Mailing Address
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Address Line | 14 DOCTORS CIR SUITE 3
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City | SUPPLY
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State | NC
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Zip | 28462-4097
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Country | US
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Telephone | 910-754-7075
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Fax | 910-754-2158
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 200101262
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License Number State | NC
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